The Linacre Quarterly 83 (3) 2016, 246–257

Article
Non-faith-based arguments against
physician-assisted suicide and euthanasia

DANIEL P. SULMASY1, JOHN M. TRAVALINE2, LOUISE A. MITCHELL3, AND

E. WESLEY ELY4,5
1
The Department of Medicine and Divinity School, The University of Chicago,
Chicago, IL, USA
2
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
3
Catholic Medical Association, Bala Cynwyd, PA, USA
4
Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt
University School of Medicine, Nashville, TN, USA
5
Veteran’s Affairs Geriatric Research Education and Clinical Center (GRECC) of the
Tennessee Valley Healthcare System, Nashville, TN, USA

This article is a complement to “A Template for Non-Religious-Based Discussions Against Euthanasia”

by Melissa Harintho, Nathaniel Bloodworth, and E. Wesley Ely which appeared in the February 2015
Linacre Quarterly. Herein we build upon Daniel Sulmasy’s opening and closing arguments from the
2014 Intelligence Squared debate on legalizing assisted suicide, supplemented by other non-faith-based
arguments and thoughts, providing four nontheistic arguments against physician-assisted suicide and
euthanasia: (1) “it offends me”; (2) slippery slope; (3) “pain can be alleviated”; (4) physician integrity
and patient trust.

Lay Summary: Presented here are four non-religious, reasonable arguments against physician-
assisted suicide and euthanasia: (1) “it offends me,” suicide devalues human life; (2) slippery
slope, the limits on euthanasia gradually erode; (3) “pain can be alleviated,” palliative care and
modern therapeutics more and more adequately manage pain; (4) physician integrity and patient
trust, participating in suicide violates the integrity of the physician and undermines the trust
patients place in physicians to heal and not to harm.

Keywords: Euthanasia, Physician-assisted suicide, Physician-assisted death, Debate, Apologetics

INTRODUCTION it would re-kindle interest in formulating

In its first issue of 2015, The Linacre Quar-
terly published the text of a secular debate
held at Vanderbilt University School of
Medicine (Bloodworth et al. 2015), hoping
arguments and contribute to increasingly
common discussions in society about
physician-assisted suicide (PAS) and
euthanasia. As that paper was offered to
engender dialog, it was hoped that other

© Catholic Medical Association 2016 DOI 10.1080/00243639.2016.1201375

Sulmasy et al. – Non-faith-based arguments against physician-assisted suicide and euthanasia
reflections would follow. As it happened,
around the same time that the Bloodworth
publication was being prepared, a debate
was held by Intelligence Squared U.S.
(Intelligence Squared 2014a) on legalizing
physician-assisted suicide featuring Pro-
fessors Peter Singer and Andrew Solomon
“for” and Doctors Daniel Sulmasy and
Ilora Finlay “against” the legalization of
PAS.1 Herein we build upon Doctor Sul-
masy’s opening and closing arguments
from that debate, supplemented by other
non-faith-based arguments and thoughts
intended to further this conversation,
focusing on objections to legalizing these
practices. In this manuscript, we will thus
review the Bloodworth article, present the
Intelligence Squared opening and closing
statements “against PAS” and then
expound upon four key arguments against
PAS: (1) “it offends me”; (2) slippery slope;
(3) “pain can be alleviated”; (4) physician
integrity and patient trust.
Before getting into Doctor Sulmasy’s
debate points, it is worthwhile to recount
some points raised in the Bloodworth article
(Bloodworth et al. 2015). While the debate
points presented at Vanderbilt were well-
received, common criticisms to some of the
assertions made in that piece are worth con-
sideration. For example, one of the main
bases for Doctor Ely’s argument against
physician-assisted suicide and euthanasia
involved an appeal to natural law.2 Such
appeal to natural law does not presuppose
belief in God. The knowledge of natural law
is discernible by reason and so it is not fun-
damentally theistic. While it is true that the
Catholic Church in particular has made
prominent use of natural law in formulating
its ethical positions, natural law is not essen-
tially rooted in any faith tradition (see, for
example, Anderson 2005; Finnis 2001;
Goyette, Latkovic, and Myers 2004; McI-
nerny 1993; Veatch 1971). Nonetheless,
appeal to natural law is commonly mistaken
as an appeal to theism, which many in a
247
secular society dismiss out of hand because
of this misperception. These critics often
forget the use of natural law reasoning by
the founding fathers of the United States.
The Vanderbilt debate, for instance, refer-
enced the Declaration of Independence,
which is a quintessentially natural law-based
set of governing principles. Lastly, the refer-
ences in that debate to C.S. Lewis from The
Abolition of Man were placed strategically
and without necessary dependence on
Lewis’s explicit arguments for theism as the
ground of the natural law, and hence moral-
ity. Lewis’s approach leaves natural law
vulnerable to the charge of theism by those
who do not accept an ultimate or transcen-
dent justice or goodness as the rule and
measure of human actions. Lewis’s position
regarding the theistic basis of natural law is
not, however, widely accepted by natural
law scholars, the authors of this paper, or
the Catholic Church.
The Bloodworth article was, as billed, a
mere starting point. Doctors Sulmasy and
Finlay developed a sophisticated, philoso-
phical “devil’s advocate” approach that was
ultimately successful. They discerned
optimal premises for making the case
against physician-assisted suicide and
euthanasia to avowed non-theistic prac-
titioners of medicine. It is thus our
privilege to publish here Doctor Sulmasy’s
points to continue building the case
towards truth in respecting human life
nearing its end in the context of the prac-
tice of the vocation of medicine. In the
tradition of St. Thomas, we take four
strong arguments for PAS that arose
during the debate (patient autonomy, no
slippery slope, unalleviated pain, phys-
ician’s duty) and argue against them. We
base our arguments in reason, with the
conviction that the truth in a principle can
be discerned and its implications drawn
out to a logical conclusion, and an error
can be shown to have a contradiction at its
heart.
248
DOCTOR SULMASY’S OPENING
STATEMENT3
I am a physician. Part of my job is to help
people die in comfort and with dignity.
But I do not want to help you, or your
daughter, or your uncle commit suicide.
You should not want me to. I urge you to
oppose physician-assisted suicide: it rep-
resents bad ethical reasoning, bad
medicine, and bad policy. I am going to
concentrate on the first of these lines of
argument. Ilora will take up the latter two.
We strongly support the right of
patients to refuse treatments and believe
physicians have a duty to treat pain and
other symptoms, even at the risk of has-
tening death. But empowering physicians
to assist patients with suicide is quite
another matter—striking at the heart not
just of medical ethics, but at the core of
ethics itself. That is because the very idea of
interpersonal ethics depends upon our
mutual recognition of each other’s equal
independent worth, the value we have
simply because we are human. Some would
have you believe that morality depends
upon equal interests (usually defined by our
preferences) and advance utilitarian argu-
ments based on that assumption.4
But which is morally more important, people
or their interests? As Aristotle observed, small
errors at the beginning of an argument lead
to large errors at the end.5 If interests take
precedence over people, then assisting the
suicide of a patient who has lost interest in
living certainly is morally praiseworthy. But
it also follows that active euthanasia ought to
be permitted. It also follows that the severely
demented can be euthanized once they no
longer have interests. They can also freely be
experimented upon as excellent human
“models” for research. It also follows that
infanticide ought to be permitted for infants
with congenital illness.
Many would see these conclusions as
frightful, but this is not just a slippery slope.
The Linacre Quarterly 83 (3) 2016
They all follow logically from arguing for
assisted suicide on the basis of maximizing
personal interests. So if you do not believe
in euthanasia for severely disabled children
or the demented, you might want to
re-think your support for assisted suicide.
At least if you want to be consistent.
People often argue that they need
assisted suicide to preserve their dignity,
but that word has at least two senses. Pro-
ponents use the word in an attributed
sense to denote the value others confer on
them or the value they confer on them-
selves. But there is a deeper, intrinsic sense
of dignity.
Human dignity ultimately rests not on a
person’s interests, but on the value of the
person whose interests they are; and the
value of the person is infinite. I do not need
to ask you what your preferences are to
know that you have incalculable worth,
simply because you are human. Martin
Luther King said that he learned this from
his grandmother who told him, “Martin,
don’t let anybody ever tell you you’re not a
Somebody” (Baker-Fletcher 1993, 23). This
some-bodiness, this intrinsic worth or
dignity, was at the heart of the civil rights
movement.
It does not matter what a person looks
like, how productive the person might be,
how others view that person, or even how
that person may have come to view
herself. What matters is that everybody,
black or white, healthy or sick, is a some-
body. Assisted suicide and euthanasia
require us to accept that it is morally
permissible to act with the specific
intention-in-acting of making a somebody
into a nobody, i.e., to make them dead.
Intentions, not just outcomes, matter
in ethics. Intending that a somebody be
turned into a nobody violates the funda-
mental basis of all of interpersonal ethics—
the intrinsic dignity of the human.
Our society worships independence,
youth, and beauty. Yet we know that
Sulmasy et al. – Non-faith-based arguments against physician-assisted suicide and euthanasia
illness and aging often bring dependence
and disfigurement. The terminally ill,
especially, need to be reminded of their
value, their intrinsic dignity, at a time of
fierce doubt. They need to know that their
ultimate value does not depend upon their
appearance, productivity, or independence.
You see, physician-assisted suicide flips
the default switch. The question the term-
inally ill hear, even if never spoken, is,
“You’ve become a burden to yourself and
the rest of us. Why haven’t you gotten rid
of yourself yet?” A good utilitarian would
think this a proper question—even a
moral duty.
As a physician who cares for dying
patients, however, I am more fearful of the
burden this question imposes on the many
who might otherwise choose to live, than
the modest restriction imposed on a few,
when physician-assisted suicide is illegal.
Assisted suicide should not be necess-
ary. Pain and other symptoms can almost
always be alleviated. As evidence, consider
that pain or other symptoms rarely come
up as reasons for assisted suicide. The top
reasons are: fear of being a burden and
wanting to be in control (Oregon Public
Health Division 2015, 5).
You may ask, “Why shouldn’t I have
this option?” And yet we all realize that
society puts many restrictions on individ-
ual liberty, and for a variety of reasons: to
protect other parties, to promote the
common good, and to safeguard the bases
of law and morality. For example, we do
not permit persons to drive when drunk,
or to freely sell themselves into slavery.
Paradoxically, in physician-assisted suicide
and euthanasia, patients turn the control
over to physicians, who assess their eligibility
and provide the means. Further, death oblit-
erates all liberty. Therefore, saying that
respect for liberty justifies the obliteration of
liberty actually undermines the value we place
on human freedom.
249
DOCTOR SULMASY’S CLOSING
STATEMENT
I have been on talk shows and received
call-in questions from patients who
ask how I can be opposed to
physician-assisted suicide when they are
getting sick from chemotherapy, suffering
complications from the big IV they have
in their neck, have intense pain, and are
spending more time in the hospital than
outside it. But I ask them, why are you
still getting chemotherapy? Why not have
the IV removed? Why not ask for hospice
or palliative care to control your pain?
Why not just stay home? You should have
no need for assisted suicide.6 Most sup-
porters of physician-assisted suicide want
what opponents want—respect for their
dignity and attention to their individual
needs.
But we are all human beings—fragile,
interdependent, and connected in bonds
of mutual respect and support. Suicide is
always an act of communication and has
profound interpersonal implications. Many
persons who raise the question of suicide
are really testing the waters, asking us if
we care enough to try to stop them. When
we do not stop them, or even say, “I’ll
help you,” we confirm their deepest fears
and make it difficult for them to see an
alternative. And when the suicide
happens, physicians and families must live
for the rest of their lives with fact that
they did not try to intervene.
We should not construct a society that
makes assisted suicide easy or common.
We should re-direct our energies towards
making sure that all patients get the kind
of care we all want—helping us live to the
fullest even as we are dying. Vote for that
kind of high quality, compassionate care at
the end of life, and the sort of moral
world that makes it possible, by voting No
on physician-assisted suicide.
250
DEBATE RESULT AND SOME OF THE
ARGUMENTS
Doctors Sulmasy and Finlay won the
debate according to its rules, by persuad-
ing the most members of the live audience
to change their minds. While the live
audience in New York City began the
debate with 65 percent in favor of legaliz-
ing assisted suicide, only 10 percent
opposed, and 25 percent undecided, after
the debate, 67 percent were in favor but
22 percent were opposed to legalization.
The unofficial online polling changed
from 5 percent opposed to legalization
before the debate to 51 percent opposed as
of March 21, 2016. (See the Results tab at
Intelligence Squared 2014a)
In the rest of this article we highlight
and expound upon some of the arguments
against physician-assisted suicide gleaned
from the debate and from the audience
comments and questions following it: (1)
“It offends me”; (2) the slippery slope; (3)
“pain can be alleviated”; and (4) physician
integrity and patient trust. We take care
not to frame them within a faith-based
context. While we believe that faith-based
arguments are strong, our intention in
arguing from reason is that all too many
people are quickly dismissive of faith-
based arguments. Our aim is to advance
the conversation from this perspective. As
noted earlier, the hope is to have new and
other iterations of the pro-life arguments
readily available to reach as broad a swath
of people as possible, believers and non-
believers alike.
“IT OFFENDS ME” ARGUMENT
Certainly everyone should strive not to be
offensive to others, but whether one is
offended or not, partly depends upon the
person potentially offended. To offend
someone is to attack, violate, or cause
The Linacre Quarterly 83 (3) 2016
resentful displeasure to a person. This pre-
supposes that the one offended recognizes
the attack, violation, or resentment, and so
the argument vis-à-vis assisted suicide is
that when one willfully kills oneself, or
requests to be killed, every other human
being should rightfully be offended.
Why? Because subsumed in the action of
one killing oneself (or requesting to be
killed) is the implied announcement that
one’s life (human life) is somehow not as
valuable as it otherwise would be if one
were not in a position to seek one’s death
(For to value life contradicts the act of
killing, and if one values life, one does
not commit suicide or ask to be killed.).
To assert that one values human life, and
at the same time to commit suicide is
contradictory and illogical. So, to kill
oneself (willfully, i.e., to distinguish this
form of suicide from suicide in associ-
ation with mental illness or other clinical
pathology) necessarily devalues human
life. And, because we are all human
beings, therefore, every human being is
(or should be) resentful of his or her life
being devalued.
Now some may grant that killing
oneself is an expression of devaluing life,
but only that individual person’s life, and
no one else’s, arguing therefore, that
there is no basis for one’s willful suicide
(or its request) to be offensive to anyone
else. The fundamental problem, however,
with this reasoning is that human beings
are relational (natural law). It is part of
the essence of being human to exist in a
relationship to another. According to
Thomas Aquinas, the third precept of the
natural law is “an inclination to good,
according to the nature of his reason …
thus man has a natural inclination … to
live in society” (Aquinas 1948, I–II,
q. 94, a. 2). And Aristotle viewed a par-
ticular relationship, that of friendship, to
be a virtue and “most indispensable for
life” (Aristotle 1962/1980, bk. 8, ch. 1).
Sulmasy et al. – Non-faith-based arguments against physician-assisted suicide and euthanasia
Indeed the very origin of an individual
necessitates the relationship of two other
human beings—a mother and a father—
and a human being exists in relationships
with others by his or her very nature.
Human beings then are always, and
essentially a part of a community of
persons, and as such because of this con-
nection with others (as part of humanity),
when another person kills him- or herself
or allows him- or herself to be killed, life
for every other human being is cheapened
(devalued). Such an action says to some
degree, that life is not worth it; and
although the effect on others may be see-
mingly miniscule, the more it happens
the greater the effect on others (like com-
pounding interest on money). Moral
actions very much and very often have
consequences for others, even when there
appears to be no connection.7
THE SLIPPERY SLOPE ARGUMENT
One of the issues brought up in the debate
over physician-assisted suicide is the slippery
slope argument: If physician-assisted suicide
is made legal, then other things will follow,
with the final end being the legalizing of
euthanasia for anyone for any reason or no
reason. The experience of other countries
shows that this is not theoretical. The
Netherlands is an example of the slippery
slope on which legalizing physician-assisted
suicide puts us. In the 1980s the Dutch
government stopped prosecuting physicians
who committed voluntary euthanasia on
their patients (Jackson 2013, 931–932; Patel
and Rushefsky 2015, 32–33). By the 1990s
over 50 percent of acts of euthanasia were
no longer voluntary. This is according to
the 1991 Remmelink Report, a study on
euthanasia requested by the Dutch govern-
ment and conducted by the Dutch
Committee to Study the Medical Practice
Concerning Euthanasia (Euthanasia.com
251
2014; Patients Rights Council 2013a; Van
Der Maas et al. 1991). In 2001 euthanasia
was made legal. And in 2004 it was
decided that children also could be eutha-
nized. According to Wesley Smith, in a
Weekly Standard article in 2004, “In the
Netherlands, Groningen University Hospital
has decided its doctors will euthanize chil-
dren under the age of 12, if doctors believe
their suffering is intolerable or if they have
an incurable illness.” The hospital then
developed the Groningen Protocol to decide
who should die. Smith comments,
It took the Dutch almost 30 years for
their medical practices to fall to the point
that Dutch doctors are able to engage in
the kind of euthanasia activities that got
some German doctors hanged after
Nuremberg. For those who object to this
assertion by claiming that German
doctors killed disabled babies during
World War II without consent of
parents, so too do many Dutch doctors:
Approximately 21% of the infant eutha-
nasia deaths occurred without request or
consent of parents. (Smith 2004)
Euthanasia in the Netherlands went from
illegal but not prosecuted, to legal, to includ-
ing children. And it is not stopping there
(Schadenberg 2013). Now, in 2011, Radio
Netherlands reported that “the Dutch
Physicians Association (KNMG) says
unbearable and lasting suffering should
not be the only criteria physicians consider
when a patient requests euthanasia.” The
association published a new set of guide-
lines, “which says a combination of social
factors and diseases and ailments that are
not terminal may also qualify as unbear-
able and lasting suffering under the
Euthanasia Act.” These social factors
include “decline in other areas of life such
as financial resources, social network, and
social skills” (RNW 2011). So a person
with non-life threatening health problems
252
but who is poor or lonely can request to
be euthanized.
In another example of the slippery slope
to which physician-assisted suicide leads,
in 2002 Belgium “legaliz[ed] euthanasia
for competent adults and emancipated
minors.” In February of 2014, Belgium
took the next step:
Belgium legalized euthanasia by lethal
injection for children…. Young children
will be allowed to end their lives with the
help of a doctor in the world’s most
radical extension of a euthanasia law.
Under the law there is no age limit to
minors who can seek a lethal injection.
Parents must agree with the decision,
however, there are serious questions about
how much pressure will be placed on
parents and/or their children. (Patients
Rights Council 2013b)
Some say that the US state laws concern-
ing physician-assisted suicide are very
restrictive and so there is no chance of
erosion such as has happened in the
Netherlands or Belgium (Intelligence
Squared 2014b, 34). Yet, if there is no
moral or philosophical basis for PAS laws
in the common good, then there is no
telling how far changes to PAS laws will
go in the future, and no stopping the
changes.
“PAIN CAN BE ALLEVIATED” ARGUMENT
In medicine, we talk much these days
about a “good death,” not necessarily one
that is completely free of suffering, but a
dying process in which we are attendant to
pain and symptom management, optimize
clear decision making, and affirm the
whole person in as dignified a manner as
possible. Importantly, this can often be
effectively accomplished through incorpor-
ation of palliative care services. Palliative
care is a healing act adjusted to the good
possible even in the face of the realities of
The Linacre Quarterly 83 (3) 2016
an incurable illness. Cure may be futile
but care is never futile (Pellegrino 2001).
With appropriate utilization of palliative
care, far fewer patients would be driven by
fear to request that physicians actively end
their lives via PAS/E.
Proponents of assisted suicide and
euthanasia posit the scenario of uncontrol-
lable pain as a straw man for advancing
their cause. Such proponents apparently
view death as the ultimate analgesic. In
fact, in medical practice today, pain relief
is almost always possible given modern
therapeutics in analgesia and the medical
specialty of pain management. Since pain
can be alleviated, there is no basis to assert
a need for PAS because of intractable
pain. This may explain in part why many
requests for PAS are no longer related to
or initiated because of intolerable pain, but
because of fear of such intolerable pain.
Further, closely related to a patient’s fear
of intolerable pain, and sometimes associ-
ated with a patient’s fear of being
abandoned (Coyle 2004), is a patient’s
request for PAS because of not wanting to
burden others. This too poses a curious
contradiction, for on the one hand there is
not wanting to be a burden on a loved
one, and on the other hand a fear of being
alone and abandoned. Such a contradic-
tion, once considered and coupled with
the fact that pain can be addressed suc-
cessfully through optimal palliative care
implementation, enhances the power of
this argument against PAS/E.
The Oregon law was enacted on the
basis of intolerable pain — no one should
be forced to endure pain that is uncontrol-
lable and unendurable. Most of us can
sympathize with that, but the law is not
restricted to pain, and it is not pain
that is the top reason people choose
physician-assisted suicide in Oregon. The
state’s “Death with Dignity Act Annual
Report” for 2014 shows that the top
reason is “losing autonomy” (Oregon
Sulmasy et al. – Non-faith-based arguments against physician-assisted suicide and euthanasia
Public Health Division 2015, 5). Concern
about pain was not even the second or
third reason: “Less able to engage in
activities making life enjoyable” and “Loss
of dignity.” It was ranked sixth out of
seven, above only financial concerns, and
included not only “inadequate pain
control,” but also “concern about it.”
These patients were not necessarily in
uncontrollable pain themselves, however
they were concerned about it (as are we
all). But even that concern did not rank
high on their list of reasons that they
wanted to commit suicide. Even if the line
drawn is unbearable pain, how can that be
restricted to only physical pain? Who can
judge that mental anguish is not unbear-
able pain? Or that economic distress (or
anything else that causes anguish) is not
unbearable pain?
PHYSICIAN INTEGRITY AND PATIENT
TRUST ARGUMENT
When a patient asks a physician to assist in
killing him- or herself, not only is there dis-
respect shown to the physician’s integrity,
but a contradiction is created. Asking a
physician to participate in PAS undermines
the principled ethic and integrity of the
physician whose noble profession is defined
as one of compassionate service of the
patient who is vulnerable, wounded, sick,
alone, alienated, afraid; and undermines the
integrity or wholesomeness of the patient,
who him- or herself is in desperate need of
trying to achieve. To ask and expect a phys-
ician to participate in the destructive act of
suicide violates both personal and pro-
fessional integrity of the physician, and
leaves both the patient and the physician at
risk for moral confusion about what is good,
true, and beautiful about the human person.
The threat of euthanasia posed by lega-
lizing PAS also undermines trust between
physician and patient.
253
Both euthanasia and physician-assisted
suicide would undermine the medical
profession by eroding the trust of patients
in their physicians as caregivers. If
doctors were permitted to engage in prac-
tices that harm their patients, then
patients would never know if their
doctors were truly acting in their best
interests. (Austriaco 2011, 148)
Will your doctor kill you if he or she
thinks you are too ill or in too much pain
or unconscious? The Oath of Hippocrates
has guided physicians for twenty-four
hundred years. The Oath states,
I will apply dietetic measures for the
benefit of the sick according to my ability
and judgment; I will keep them from
harm and injustice…
I will neither give a deadly drug to
anybody who asked for it, nor will I make
a suggestion to this effect. Similarly I will
not give to a woman an abortive remedy.
(Tyson 2001)
Even with all the advances in medicine
over the last one to two hundred years, the
public perception is still that the Hippo-
cratic Oath is an important indicator that
the patient in his or her vulnerability can
put trust in the physician (Lederer 1999,
102). Euthanasia by health-care pro-
fessionals undermines that trust.
Lack of trust is not just something that
may or may not happen if euthanasia is
legalized. It is happening in countries that
have legalized euthanasia. Austriaco points
out that “many Dutch patients, before
they will check themselves into hospitals,
insist on writing contracts assuring that
they will not be killed without their expli-
cit consent” (Austriaco 2011, 148). As
stated earlier, in the 1980s the Dutch gov-
ernment stopped prosecuting physicians
who committed voluntary euthanasia on
their patients. By the 1990s over 50
percent of acts of euthanasia were no
longer voluntary. This has had a
254 The Linacre Quarterly 83 (3) 2016

deleterious effect on the relationship of SUMMARY

patients to health-care professionals. An
article in 2011 in the Telegraph, a newspa-
per in the UK, stated that “Elderly people
in the Netherlands are so fearful of being
killed by doctors that they carry cards
saying they do not want euthanasia”
(Beckford 2011). The Dutch elderly mis-
trust their own doctors.
Trust is not the only issue concerning
the integrity of medicine: PAS also calls
into question the very ends of medicine to
cure and to care. Christopher Saliga, a
nurse, explains that
One can rightly say that in Oregon, the
balance has shifted such that respect for
autonomy currently has greater weight
among the principles hanging in the
balance than it had prior to the legaliza-
tion of assisted suicide. As a result, the
contradictory patient outcomes of life and
death via continued care or willful suicide
respectively are considered equally valid.
(Saliga 2005, 22–23)
Medicine and the medical profession tra-
ditionally aimed at curing and healing.
Assisting in a suicide is neither cure nor
healing. It pits the medical profession
against itself: curing and caring versus
killing.
We offer the following table of the salient
points comprising the non-faith-based
arguments against PAS (Table 1).
CONCLUDING REMARKS
As the secular world pushes more and more
the agenda of personal autonomy and relati-
vism, breeches of long-held ethical
standards and our oath as physicians are
increasingly apparent. On this topic of PAS
and euthanasia, it is worth pointing out that
in the practice of critical care medicine at
the highest level of academia, there are now
movements to endorse “shortening of the
dying process” (SDP), which is a euphe-
mism for physician-assisted suicide at best,
and in effect, a synonym for murder when
unilaterally committed by a health-care pro-
fessional in the absence of legal approval. In
fact, in one Belgian statement, the authors
endorsed using medications to end patients’
lives even in the absence of suffering (Vincent
et al. 2014, n. 6), a practice that was found
offensive and actively rebutted by a group of
Dutch physicians (Kompanje et al. 2014).
Such SDP is a practice that was reported by
2 percent of physicians in seven European
countries (Sprung et al. 2003), but which is

Table 1 Non-faith-based arguments against physician-assisted suicide and euthanasia

Argument Main points

“It offends me” Life has infinite value, and PAS devalues life
Devaluation of life is offensive
Human beings are relational and share in value of life
PAS is an offense to all human beings
Slippery slope PAS in limited circumstances has led to PAS performed with markedly reduced
limits (e.g., children, disabled people)
“Pain can be alleviated” Embracing excellent palliative care is the correct answer
Physician integrity and PAS undermines the integrity of both physician and patient as it is a contradiction
patient trust to the patient’s seeking to be well; and a violation of the principled duty of the
physician to help the patient to become well
Undermined physician integrity is leading to loss of patient trust in physicians
Sulmasy et al. – Non-faith-based arguments against physician-assisted suicide and euthanasia
felt by 79 percent of physicians to be wrong
and intolerable even if allowed by law
(Sprung et al. 2014). With such active con-
versations occurring, especially now that the
Canadian Supreme Court has recently ruled
in favor of physician-assisted suicide, it is
more important than ever to be adept with
defense of life arguments, which are also
arguments in defense of the healing pro-
fession of medicine at large.
All is not lost in medicine just because
we have no cure and see a patient’s life
nearing its end. This represents a time in
which we as physicians must focus, as
Edmund Pellegrino taught, on elevating
human dignity and the preservation of
self-worth for each and every patient:
To care, comfort, be present, help with
coping, and to alleviate pain and suffering
are healing acts as well as cure. In this
sense, healing can occur when the patient
is dying even when cure is impossible.
Palliative care is a healing act adjusted to
the good possible even in the face of the
realities of an incurable illness. Cure may
be futile but care is never futile. (Pelle-
grino 2001)
We invite others to contribute to this
ongoing debate, and to continue the
dialog, hoping that some of it will be cap-
tured on the pages of this journal.
NOTES
1 Intelligence Squared U.S. is a program
which presents prominent figures before a
live audience debating important timely
issues of our time. More information can be
found at http://intelligencesquaredus.org.
2 In essence, the natural law expresses the
original moral sense which enables man to
discern by reason the good and the evil,
the truth and the lie. Catechism of the
Catholic Church (2000), n. 1954.
3 Doctor Sulmasy’s opening and closing
statements are printed verbatim. A few
notes and references have been added. For
255
the transcript, see Intelligence Squared
(2014b).
4 See Singer (1993, 13–14, 21–26, 57, 94–
95).
5 Aristotle. On the heavens (I.5, 271b9–10),
in The Basic Works of Aristotle, ed. Richard
McKeon (New York: Random House,
1941), 404.
6 The authors’ understanding of palliative
care is that it is present first and foremost
to help the patient (and family) live maxi-
mally in the face of life-threatening illness
and, in that sense, can provide great
benefit to the patient and loved ones well
before he or she is imminently dying.
Whenever it is deemed appropriate in the
course of a patient’s life and dying process,
the palliative care team’s focus on “iving
maximally” may be best achieved by coor-
dinating activities to optimize the patient’s
comfort, function, relationships, healing,
dignity, and preparation for natural death.
7 Further, if we were to develop this line of
reasoning in a faith-based model, it would
involve the notion that there is no such
thing as a private sin.
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BIOGRAPHICAL NOTE
Daniel P. Sulmasy, M.D., Ph.D., is the
Kilbride-Clinton Professor of Medicine
and Ethics in the Department of Medi-
cine and Divinity School; associate
director of the MacLean Center for Clini-
cal Medical Ethics in the Department of
Medicine; director, Program on Medicine
and Religion at the University of Chicago.
Deacon John M. Travaline, M.D., is a
professor of Thoracic Medicine and Surgery
at the Lewis Katz School of Medicine at
Temple University, Philadelphia, PA, USA.
Louise A. Mitchell, M.T.S., M.A., is
associate editor of The Linacre Quarterly,
and an adjunct professor of bioethics.
E. Wesley Ely, M.D., M.P.H., is a pro-
fessor of Medicine and Critical Care at
Vanderbilt University, the Vanderbilt Center
for Health Services Research, and associate
director of Research for the Tennessee
Valley VA Geriatric Research Education
Clinical Center in Nashville, TN, USA.